Week 6 Diuretics_UTI_Bladder

Question 1

Loop Diuretic
-decrease fluid volume

Answer 1

Furosemide (Lasix)
Torsemide -more modern

-emide

Question 2

Furosemide and torsemide MOA

Answer 2

Block the chloride pump in the ascending loop of Henle.
This causes reabsorption of sodium and chloride.
Decreased fluid volume

Question 3

what is the indication for the loop diuretics furosemide and torsemide

Answer 3

Edema, Hypertension, acute pulmonary edema
Getting rid of extra fluid
Extra fluid= HTN

Question 4

are loop diuretics given to treat HTN alone?

Answer 4

no they work adjacently with other meds

Question 5

What are the side effects/ adverse effects of loop diuretics furosemide and torsemide?

Answer 5

Reabsorbs the sodium,
hypokalemia-potassium loss is a high risk of losing too much K+
Hyperglycemic
*Hyperuricemia-getting rid of extra fluid causes a higher concentration of uric acid

Dizziness nausea and vomiting due to decreased fluid volume: aka symptoms of dehydration

Question 6

What meds and conditions would interact/contraindication?
loop diuretic

Answer 6

NSAIDs,
Salicylates (asprin)
*Contraindication: Gout- causes concentration so antigout treatment will be given

Question 7

nursing implications for loop diuretics surrounding the patients consumption?
-furosemide and torsemide

Answer 7

• Drink with milk to decrease gastric irritation
• Increase K-rich foods-
  Oranges, dates, apricots, raisins, broccoli, green beans, potatoes, meats, fish legumes, salt substitutes

-due to drug-releasing so much K+ its important to restore through diet

Question 8

What would a nurse assess for a patient on a loop diuretic?

Answer 8

• Daily weights, (nurse monitor I & O)
• Muscle weakness, constipation, irregular pulse, and lethargy are all signs of hypokalemia*
  -Uric acid levels as well!
• potassium levels!
• blood glucose levels if the pt is diabetic (hyperglycemic affect)

Question 9

What should a pt report immediately if they are on a loop diuretic?

Answer 9

• Muscle weakness, constipation, irregular pulse and lethargy are all signs of hypokalemia (potential medical emergency)
• Report immediately N/V, or diarrhea ( creates fluid and electrolyte imbalances)

Question 10

thiazide diuretic example

Answer 10

Hydrochlorothiazide- HCTZ

Question 11

MOA of HCTZ

Answer 11

Inhibit tubular resorption of sodium, chloride, and potassium ions
in the distal convoluted tubule
Result: water, sodium, and chloride are excreted

Question 12

what is the indication for hydrochlorothiazide

Answer 12

Edema, monotherapy or adjunct for treatment of hypertension

Question 13

what are the side effects of hydrochlorothiazide? what do they relate to?

Answer 13

Dizziness, orthostatic hypotension, dehydration,
hypokalemia- (all pertain to fluid loss symptoms)

Hyperglycemia, hyperuricemia, (caution with gout and diabetes )

Photosensitivity,

Question 14

what would contraindicate hydrochlorothiazide diuretic

Answer 14

Caution with Diabetes
Gout- can cause flare-up

Question 15

what would a nurse want to be aware of when giving hydrochlorothiazide

Answer 15

may need increased dose of insulin
-Wearing sunscreen/limit sun
-be aware of hypokalemia
- monitor uric acid

Question 16

osmotic diuretic example

Answer 16

mannitol

Question 17

mannitol MOA

Answer 17

Pull water into the renal tubule without sodium loss
Inhibit tubular resorption of water and solutes, thus producing rapid diuresis

Question 18

Indication for mannitol osmotic diuretic

Answer 18

: Reduces Intracranial pressure or cerebral edema associated with head trauma
-lowers head swelling fluid

Question 19

what is the SE AE of manitol

Answer 19

Relate to the sudden drop in fluid levels:
if someone is dehydrated….
They will have nausea and vomiting,
hypotension,
light-headed,
dizzy, confusion, headache,
dryness, temp

Question 20

what is the SE AE of mannitol

Answer 20

Relate to the sudden drop in fluid levels:
if someone is dehydrated….
They will have nausea and vomiting,
hypotension,
light-headed,
dizzy, confusion, headache,
dryness, temp

Question 21

what are the potential serious adverse effects of osmotic diuretics mannitol

Answer 21

Convulsions and pulmonary edema

Question 22

nursing implications for a patient on an osmotic diuretic mannitol

Answer 22

Nursing Implications: Assess:
* IV only and must use a filter*
* LS- Osmotic diuretic can precipitate heart failure and pulmonary edema

Question 23

IV for mannitol must have a what?

Answer 23

filter!

Question 24

why should the nurse assess for lung sounds on a pt on an osmotic diuretic? what noises would a nurse find?

Answer 24

Crackles:
Pt with heart failure or pulmonary edema will have crackles
-mannitol pulls off fluid but, pulmonary edema has a build-up in the lungs causing crackles

Question 25

potassium-sparing Diuretics examples

Answer 25

Spironolactone
Triamterene

Question 26

MOA for K sparring diuretic spironolactone and triamterene

Answer 26

Cause a loss of sodium while retaining potassium
* Prevent potassium from being pumped into the tubule, thus preventing its secretion
* Block the actions of aldosterone in the distal tubule

Question 27

Indication for potassium sparing diuretics

Answer 27

Hypertension, Edema in patients who are at risk for hypokalemia

Question 28

K sparring diuretic spironolactone and triamterene SEAE

Answer 28

SE/AE: Dizziness, Cramps, nausea, vomiting, hyperkalemia, hyponatremia

Question 29

what would you monitor for on a patient with K sparring diuretic

Answer 29

Monitor for hyperkalemia

Question 30

pt education for those on a k sparring diuretic spironolactone and triamterene

Answer 30

Salt substitutes make sure to educate on the use of salt-substitutes like K
Mrs dash is an example

Question 31

Nursing considerations for all Diuretics
Assessment

Answer 31

Fluid or electrolyte disturbances,
gout,
glucose levels,
edema,
weight, I&O, K levels

Question 31

Nursing considerations for all Diuretics
Assessment

Answer 31

Fluid or electrolyte disturbances,
gout,
glucose levels,
edema,
weight, I&O, K levels

Question 32

Nursing considerations for all Diuretics

Answer 32

Pt ed:
Weigh daily, same scale and time
Report significant weight gain
(A couple pounds a day or 5 a week)
Do not take dose at night
(The latest does should be given no later than 4PM)
Change positions slowly
Notify provider immediately for rapid heart rate and syncope
-because of hypotension and fluid loss

Question 33

therapeutic effects a nurse should monitor for all diuretics

Answer 33

Monitor for therapeutic effects:
* Reduction of edema
* Reduction of fluid volume overload
* Improvement in manifestations of HF
* Reduction of hypertension
* Return to normal intraocular pressures

Question 34

Anti-invectives for UTI’s

Answer 34

Norfloxacin
Nitrofurantoin

Trimethoprim-

Question 35

Norfloxacin
Nitrofurantoin
MOA

Answer 35

Act specifically within the urinary tract to destroy bacteria

Question 36

Anti-invectives for UTI’s indication
Norfloxacin
Nitrofurantoin

Answer 36

: Chronic UTI, Prophylaxis

Question 37

Norfloxacin
Nitrofurantoin SEAE

Answer 37

nervousness, confusion, Nitrofurantoin- dyspnea, chest pain, chills, fever, & cough

Question 38

what should a nurse assess for a pt on norfloxacin and nitrofurantoin

Answer 38

Assess-
Urinary elimination patterns
-how much are they voiding, how often, frequency urgency and pain or difficult voiding
If they have symptoms of a UTI is the UTI effective?

Question 39

Trimethoprim- Sulfonamide (Septra DS) indication

Answer 39

UTI’s with E.Coli

Question 40

what are the SE AE of trimethoprim

Answer 40

Kidney stones, Stevens-Johnson syndrome
-blistering of the skin red and raw

Question 41

Nsg implications for trimethoprim

Answer 41

-Take on empty stomach with 8oz H2O,
- Complete course of therapy,
-Use additional contraception, Important—
-number one risk of UTI is female, remember the best way to prevent recurrence is preforming proper peri care front to back.

Question 42

Antispasmodics
(anticholinergics)
examples

Answer 42

Oxybutynin (Ditropan XL)
Tolterodine (Detrol)

Question 43

Oxybutynin (Ditropan XL)
Tolterodine (Detrol)
MOA

Answer 43

Block the spasms of urinary tract muscles

Question 44

Oxybutynin (Ditropan XL) and Tolterodine (Detrol) indication

Answer 44

Urinary frequency, urgency & urge incontinence caused by Bladder spasm and overactive bladder

Question 45

antispasmodic SE AE

Answer 45

SE/AE:
Dry mouth blurred vision constipation anything drying

Question 46

antispasmodic interactions

Answer 46

Haloperidol
-anticholinergic increasing risk of side effects of haloperidol
Contraindication: Obstructive urinary tract problems

Question 47

What should a pt on antispasmodic drugs report to physician

Answer 47

should report the following symptoms to their physician:
-urinary hesitancy or retention,
- constipation,
- tachycardia, palpitations,
- tremors,
- confusion, sedation, hallucinations
- decreased sweating (leading to hot, dry skin

Question 48

Phenazopyridine (Pyridium) MOA

Answer 48

When phenazopyridine is excreted in urine, it exerts a direct topical analgesic effect on the urinary mucosa

Question 49

Urinary tract analgesia ex,

Answer 49

Phenazopyridine (Pyridium)

Question 50

indication for urinary tract analgesia

Answer 50

dye that is used to relieve urinary tract pain and urgency.
Pain can be related to infection, trauma, or surgery

Question 51

SE of urinary tract analgesia phenazopyridine
nsg implication related to SE

Answer 51

Urinary discoloration
-reddish orange color looks like bleeding but the dye will discolor the urine
Nursing Implications:
Edu on urinary discoloration is normal and expected

Question 52

doxazosin
finasteride
tamsulosin
terazosin
are what

Answer 52

Alpha1-andrenergic blockers

Question 53

alpha1 -adrenergic blockers indication
SE AE
Interactions

Answer 53

loss libido
ED
dizzy
hypotension
interact with alpha blockers because they increase antihypertensive effects

Question 54

alpha1 - adrenergic blockers nsg implications

Answer 54

assess renal and liver function
PSA
intraocular pressure
and BP